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EXISTING SYSTEM EVALUATION REPORT x EXISTING SEPTIC TANK EVALUATION REPORT <br /> Existing System Evaluation Report for Onsite <br /> Wastewater Systems <br /> DEQ <br /> State of Oregon Department of Environmental Quality <br /> Onsite Program <br /> 165 East 7th Avenue,Suite 100 <br /> Eugene,Oregon 97401 <br /> Please answer the following questions completely.Uo not leave any blank responses.Write unknown it <br /> unknown.Refer to Oregon Administrative Rule 340-071-0155 for more information,and please visit <br /> Trt.a. <br /> Septic System Owner-Provided Information: ,_ <br /> 1'nopnty owner(sgSetten) FRANK IIAASSEI! Telephone <br /> Sr1PAddress 50617 LINNWOOD DR <br /> City: GATES Zip Code: 97346 <br /> County: GATES 17,711SQFT Acres/Square sire' Feet(circle units) <br /> legal Description' T 9S R 3E SEC 26CD IL 203 <br /> Age of wastewater treatment system N/A (years) litho*a service cont <br /> ract for system components? NO <br /> Date the sep1K tank was last pumped UNKNOWN <br /> (please attach receipt H available) <br /> Number of pro*octupykyt the Media( N/A if <br /> was ties section tom unoccupied,how ions has it been vacant N/A <br /> pletei by the evaluator because own Of agent was tWva sbt,? <br /> the above information Is true and to the best of my knowledge., YE5 <br /> 11/13/2020 <br /> l,.qrr,(MeivD, ) SPOKE WITH FRANK MASSER BY PHONE <br /> Name of person pertortn Signature o/Own', <br /> ion(ptease print) CHRIS RHODAMACK <br /> crate,[„„, <br /> Instalie( <br /> X Maintenance.Prwlder rkolnskrnal tnet+w,er <br /> Natxmal Association of Wattewatw Ter hnkians Y,rrvircxwne.'ntal Health'.psv;yh nt <br /> mhec lit appruvr!d el wrrllnX(please des,rt.") Westewatn 1nerwlnt <br /> t.etifKrxn Nuxntwr: RM 8 <br /> ntrskness name A i 11 tic.WPM e/valy'y Se piX Se.r+(c <br /> tkutness addrn e,Q,s. (:mail <br /> t?2��4�4 AI4anIr.t7r.4J11 <br /> Pruu>!. 1 it66911 11% --_ <br /> Oate of tvahratkxn 12/2/2020 <br /> _ _(MM/[Ni/vvey} <br /> I hereby certify,by my signature,that I meet all of the qualifications required to perform txsite rracstewnter <br /> system evaluations In the state of Oregon pursuant to OAR 3404,1/I 01SS. <br /> 12/2/2020 <br /> Uate(►rM/° rrrrl CHRIS RHODAIIACK <br /> %illn44ev of Quabfiest Sept,.System inspector <br /> Page 1 of 8 <br /> Updated 12//9/)016 <br />